In the
United States (US)
stroke care has undergone a remarkable transformation in the past decades at several levels. At the clinical level, randomized trials have paved the way for many new
stroke preventives, and recently, several new mechanical clot retrieval
devices for
acute stroke treatment have been cleared for use in practice by the US Federal
Drug Administration. Furthermore, in the mid 1990s we witnessed regulatory approval of intravenous recombinant
tissue plasminogen activator for
administration in
acute ischemic stroke. In the domain of
organization of
medical care and delivery of
health services,
stroke has transitioned from a
disease dominated by neurologic
consultation services only to one managed by vascular
neurologists in geographical
stroke units,
stroke teams and
care pathways, primary
stroke center
certification according to The
Joint Commission, and most recently comprehensive
stroke center designation under the aegis of The
Joint Commission. Many
organizations in the US have been involved to enhance
stroke care. To
name a few, the
American Heart Association/American
Stroke Association,
Brain Attack Coalition, and National
Stroke Association have been on the forefront of this
movement. Additionally, governmental initiatives by the US
Centers for Disease Control and Prevention and
legislative initiatives such as the Paul Coverdell National
Acute Stroke Registry program have paved the way to focus on
stroke prevention, acute
treatment and
quality improvement. In this invited
review, we discuss a brief
history of organized
stroke care in the
United States, evidence to support the value of primary and comprehensive
stroke centers, and the
certification criteria and process to become a primary or comprehensive
stroke center.